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Suicidal Behavior, a Survey of Oregon High School Students, 1997

REFERENCES and ENDNOTES

1. The number of suicides may be larger; medical examiners were unable to determine whether the death was intentional or unintentional for ten 10- to 19-year-olds. In addition, some suicides committed by crashing a motor vehicle may not be recognized; an estimated 1.6% to 5.0% of vehicular fatalities are believed to be suicides that escaped detection. (Peck DL, Warner K. Accident or suicide? Single-vehicle car accidents and the intent hypothesis. Adolescence. 1995. 30:463-472; Schmidt CW, et. al. Suicide by vehicular crash. Am J Psych. 1977; 134:175-178).

3. These rates are based on relatively few events and therefore are subject to considerable random statistical variation.

4. Personal communication. There has been no change in how suicides are classified over the past several decades. Karen Gunson, MD, Oregon Deputy State Medical Examiner.

5. These data are based on the CDC's WONDER (Wide-ranging On-line Data for Epidemiological Research) system. Because the National Center for Health Statistics (NCHS) does not include updated cause of death data available to the Oregon Center for Health Statistics (OCHS), the Oregon rate in WONDER is under-stated.

6. Meehan PJ, et al. Attempted suicide among young adults: Progress towards a meaningful estimate of prevalence. Am J Psychiatry 1992.: 149: 41-44. Another Health Division dataset, the Adolescent Suicide Attempts Data System (ASADS), a hospital based reporting system of attempts by youth under 18 years-old also indicates that there are fewer suicide attempts than YRBS data would suggest. The ASADS data are published annually by the OCHS in the Oregon Vital Statistics Annual Report.

11. Garnefski N, Diekstra RFW, de Heus P. A population-based survey of the characteristics of high school students with and without a history of suicidal behavior. ACTA Psychiatr Scand. 1992; 86:189-196.

12. Socioeconomic rank was based on the percent of students eligible for free or reduced price lunch, student mobility rate, student attendance rate, and the level of education of the most educated parent, as determined by the Department of Education (DOE Statewide Assessment).

20. Responses to the physical abuse question were missing or invalid for 22 percent of the cases, by far the highest for any of the survey questions; therefore, these data should be used with caution. Responses to the sexual abuse question were missing for 10 percent of the cases, the third highest value recorded for the survey questions discussed herein.

21. Nine percent of students reported being both physically and sexually abused.

22. Sedlack AJ, Broadhurst DD. Third National Incidence Study of Child Abuse and Neglect. US DHHS, Administration for Children and Families. Washington, DC. 1996.

23. Three percent of males and 14% of females reported being both physically and sexually abused. Just 73% of males and 61% of females reported neither type of abuse. For both sexes combined, the figure was 67%.

29. In 37% of all households with a high school student, someone smoked, 19% in the home and an additional 18% outside the home.

30. Females were four times more likely to use extreme measures for weight control (8% vs. 2% of males). However, both genders using these weight control measures were three and one-half times more likely to attempt suicide than were their peers who abstained from these methods.

38. Fully 27% of the students who said they were treated for a suicide attempt by a doctor or nurse within the last year, when asked later in the survey when they last saw a doctor or nurse, said they had not seen these medical providers during the previous year. This suggests that perhaps as few as 1.6%, or 2,524, (rather than 2.2%, or 3,470) made an attempt that required care by medical personnel, and given the findings of Meehan et al, this figure may still be inflated. However, it is unknown how students interpreted the second question (i.e., whether they responded that they had not seen a doctor or nurse during the prior 12 months because they had already stated that they had been treated for an attempted suicide within the past year). Oregon, unlike other states, has a hospital-based suicide attempt reporting system for youth under 18 years old (however, some hospitals do not provide complete data). The true number of attempts requiring professional medical care probably lies between the 736 attempts reported by hospitals during 1997 and the figures estimated from the YRBS.

60. Oregon law (ORS 441.750) requires that youths (under 18 years of age) who are treated by hospital for a suicide attempt be referred for appropriate intervention. However, the degree of compliance, availability of resources and follow-up is unknown.

61. American Academy of Child and Adolescent Psychiatry. http://www.cmhc.com/factsfam/suicide.htm.

62.
Adapted from American Association of Suicidology. http://www.cyberpsych.org/aashelp.htm and the San Pedro Youth Coalition. http://www.sanpedro.com/spyc/talks.htm

64. The NIS-3 found that 72% of physically abused children were abused by their natural parents while other parents and parent substitutes (e.g., boyfriend or girlfriend of parent) accounted for 21%. Among sexually abused children, 29% were abused by their natural parents and 25% by other parents or parent substitutes.

65. These percentages, and others showing the percentage of attempts resulting in death, represent maximum values because an unknown number of attempts may have been unreported.

66. All seasonal and other temporal data are for youth suicide are for the years 1987-96.